Health Information Management

Pay-per-view: Simplify the decision to use modifier -59

APCs Insider, August 31, 2012

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A surgeon performs a diagnostic shoulder arthroscopy before repairing a patient’s rotator cuff. The surgeon knew ahead of time that he or she would be repairing the rotator cuff. Should a coder or biller append modifier -59 (distinct procedural service) to the CPT® code for the diagnostic shoulder arthroscopy to ensure reimbursement for both procedures?

Most coders and billers probably know that they cannot unbundle those two procedures. According to the CPT guidelines and the NCCI edits, the diagnostic arthroscopy is part of the surgical procedure.
Continue reading “Simplify the decision to use modifier -59” on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the August issue.

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